For an "accidental nurse", Judy Kilpatrick has had a
profound impact on the development of the profession in New Zealand.

The head of the University of Auckland's (UoA) nursing school
since its foundation in 1999 retires this month after a nursing career
spanning close to five decades. That career began at Christchurch
Hospital in January 1968. She had always intended going to university
--law or teaching history appealed. But on a whim one day, after
she'd left school, she wandered past the hospital, went in, asked
about nursing and emerged signed up for the next intake.

There's nostalgia as she recalls her student days under the
apprenticeship model of training, which was "lovely and
appalling". Students were a significant part of the nursing
workforce and "we bungled through, taking advice from slightly more
senior nurses. The attrition rates were terrible and we were so
young". But she learned to take responsibility and there were other
compensations. "Living in the nursing home meant there was always
someone to debrief with, to drink coffee with late into the night. I
still have friends from those days."

Ironically, the woman who has been a champion of tertiary-based
education for nursing and a powerful advocate for postgraduate nursing
education, loved her hospital-based training. She has never regretted
her on-a-whim career choice.

Rising through the ranks

After graduating, she went into accident and emergency (A&E)
nursing, quickly rising through the ranks to become charge nurse at
Green Lane Hospital's A&E department before becoming senior
supervisor at the hospital. "I worked under Matron Margaret Taylor
who allowed you to have a go. We introduced primary nursing and nurses
were allowed to set their own rosters. That was unheard of; that power
previously resided with charge nurses who could punish a recalcitrant
nurse with a ghastly roster. It was a great place to work and Margaret
Taylor was a wonderful mentor."

Her "teaching urge" remained and she started teaching
Auckland and Green Lane Hospital nursing students. After a year at
Wellington's School of Advanced Nursing Studies, she returned to
clinical practice at Green Lane Hospital.

In 1981, she "took the plunge and joined Yvonne
Shadbolt's small team at the then Auckland Technical Institute
(ATI)". This new breed of nursing students, educated in tertiary
institutions rather than hospitals, were still considered "weird
beasts".

Shadbolt was another great mentor who encouraged Kilpatrick and
gave her plenty of opportunities. She rose through the ranks at ATI,
subsequently Auckland Institute of Technology and then Auckland
University of Technology (AUT), from course supervisor to associate head
to head of school. "I never escaped from teaching."

Kilpatrick has been a dominant and, at times, divisive figure in
nursing education, unconcerned about attracting flak and passionate
about university-delivered postgraduate education and advanced practice.
And, as the head of the nursing school at Ara, Cathy Andrew, pointed
out, able to navigate the political minefields of education and health.

There's a fearlessness about her. Head of Victoria
University's graduate school of nursing and midwifery Kathy
Holloway said Kilpatrick was not afraid to lead change from the front
and "to strategically challenge the status quo with charm and
wit".

Behind the garrulous, laughing and seemingly casual persona is a
tough intellect--"I'm smart rather than intelligent"
--and an entrepreneurial spirit. She also has the ability to grasp the
big picture--"I'm not a details person" and see where and
how nursing should best position itself.

That fearlessness and her ability to discern trends, have seen her
champion advanced practice and, in her time as Nursing Council chair
from 1996 to 2002, guide the development of the nurse practitioner (NP)
role. She was chair of the council when the country's first NP,
Deborah Harris, was registered.

A latter-day successor at AUT, current head of school Stephen
Neville, says as a young nurse he was "in awe of this tall,
articulate and passionate woman who was fearless in her defence and
support of the development of advanced nursing practice roles".

Holloway said Kilpatrick was "a trailblazer and policy
entrepreneur" who raised political awareness of the importance of
advanced nursing practice. "Her voice will be missed in those
conversations," she said.

Kilpatrick remains convinced that getting that "top layer of
expert clinician, the NP, right," has meant other specialist
clinical roles have developed. "All other roles have fallen out of
that because the career pathway--from degree entry to top clinician--is
in place, and where other roles fit on that pathway is clear. Nurses can
choose how far they want to progress on that pathway. Not everybody
wants to be an NP."

Professor of nursing at Massey University Jenny Carryer describes
Kilpatrick as a "larger-than-life leader" who has used
determination, humour and vision to power through many important changes
for nursing. "Her contribution has been huge and
long-standing," she said.

Postgraduate education was an essential component of the nursing
pathway and, in her role as head of the UoA's nursing school,
Kilpatrick has driven that agenda hard. As the inaugural head of a
nursing school set up within an established medical school, she was
criticised by some who feared a return to doctor-dominated nursing
education. And that's another skill--an ability to work alongside
medical colleagues--"I love the docs"--while also challenging
their power and their stranglehold on funding, particularly in primary
health care.

Establishing the nursing school at the UoA, now within the Faculty
of Medical and Health Sciences, has enhanced inter-professional
education and collaboration, strengthened nursing's scientific
foundation and placed postgraduate nursing education within "the
normal academic framework", she says. This semester the school has
1200 postgraduate nursing students and "a small but perfectly
formed" undergraduate programme, with 100 first-year students.

Kilpatrick is adamant postgraduate nursing education should be
delivered in universities--"the resources to underpin that
education are available there". The exposure to other disciplines
is "marvellous and brings confidence. Nursing has been too insular
for too long".

Referring to funding for postgraduate education, she says
"nurses sometimes forget how lucky they are. Most nursing
postgraduate study is funded--course fees through Health Workforce New
Zealand and study leave through DHBs. And postgraduate study means
nurses are equipped to apply for more senior positions, which attract
more money."

But she has "total admiration" for the time and
dedication so many nurses spend on that education.

On undergraduate education, she says there's no risk of a
two-tier system developing between university--or institute of
technology-prepared students. "The undergraduate programme can be
taught at both." She sees institutes of technology as the natural
place for health care assistant and enrolled nurse programmes.
She's convinced enrolled nursing is going to come back into its
own. "Universities aren't going to provide those courses.
That's not being elitist; it's about encouraging institutions
to do the stuff they're really good at."

She thinks there are too many undergraduate nursing schools.
"But in smaller centres, they give people an opportunity to get
educated in their home town and give second-chance learners a way of
getting a degree. And at some institutes, the nursing programme is the
only course holding those places up."

She's not convinced every nurse should be guaranteed a job at
the end of their degree. "What other profession--apart from
doctors--expects a job at the end of their training? Most get a job
within a year of finishing their education."

Speaking more generally about the profession, she bemoans the fact
nursing takes itself "terribly seriously" and would dearly
love it to "lighten up". She'd also dearly love nurses to
be far more politically savvy. "You've got to be political if
you are going to make change."

And nurses "have stayed out of the money game" to their
detriment. "That unwillingness held up the development of the NP
role."

She's glad chief nursing officer Jane O'Malley has
gathered a team of nurses around her and sits on the Ministry of
Health's executive leadership team. It's "disgraceful and
unacceptable" that not all directors of nursing (DoNs) are on their
district health boards' (DHBs) executive leadership teams.
Kilpatrick would love all DoNs to have responsibility for nursing
budgets. "Very few do and it is apparent which ones do, because
they bring a different strength to the job."

She's bewildered by "the way nurses turn on themselves.
What the hell is that all about?" she asks. There are lessons to be
learned from doctors, whose squabbling "all happens behind closed
doors". Answering her own question, she believes the
"highly-stressed" health system is one reason, and also the
lack of joy in that system. "When I was nursing, it was a joyous
occasion when someone was discharged fully recovered. Now we send people
home who are still quite sick, so the joy of seeing someone go home well
is missing."

As she faces retirement and acknowledges the profession's
progress, she admits funding remains a stumbling block to innovation and
truly autonomous practice. "Funding models, particularly in primary
care, have to change, to enable both nurses and GPs to work at the top
of their scopes. Funding for nursing has been an issue as long as I can
remember."

She's going to miss the education milieu "terribly.
I've really loved my working life and have no regrets at all. But
it's time to move on."

Neville says, in the years since he was in awe of her, "we
have gotten to know each other well and I appreciate her significant
contribution to our profession."

Life in retirement includes a partner, a year-old grandson in
Melbourne, a lifestyle block in Kumeu, a beach house at Mangawhai and
some voluntary work. But she doesn't rule out some future
involvement in the profession that has been her lifeblood.
"I'm not actively looking but if something comes along that I
can turn my hand to, I may be interested."

By co-editor Teresa O'Connor

Caption: Judy Kilpatrick who retires this month.

Caption: Judy Kilpatrick when she began at AIT in 1981.

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